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Background: Over the last 12 years, the demographic and clinical characteristics of patients undergoing myocardial revascularization surgery have evolved rapidly. The goal of our study was to analyze the evolution of these trends and the results of these surgical interventions.Methods: We identified patients who underwent a first or second myocardial revascularization between 1993 and 2004, and we arbitrarily divided them into 2 groups: 1 cohort of patients who underwent surgery between 1993 and 1998 and 1 cohort of patients who underwent surgery between 1999 and 2004. We compared demographic and clinical characteristics between the 2 cohorts and determined which variables were significant predictors of morbidity and mortality.Results: From 1993 to 2004, 12 202 patients underwent a first (95.5%) or second (4.5%) myocardial revascularization. Patients in the later cohort presented with a high-risk profile. They were older and had metabolic syndrome or diabetes and peripheral vascular disease. On the other hand, there were fewer active smokers in this group. Whereas the rate of postoperative infarction and renal insufficiency was higher in the second cohort, this group had a lower incidence of stroke and prolonged mechanical ventilation and shorter hospital stays. Overall, observed mortality decreased in spite of a steady increase in predicted mortality. Identified predictors of mortality were age, stroke, female sex, nonelective surgery, renal insufficiency, peripheral vascular disease, chronic obstructive pulmonary disease, ventricular dysfunction and stenosis of the left main trunk.Conclusion: Our study confirmed current trends that show an increase in the at-risk population with dysmetabolic syndrome in cardiac surgery, as well as constant improvements in tertiary care in anesthesia and coronary surgery. [ABSTRACT FROM AUTHOR]

Purpose: Determine the effects of skin temperature change on bench-pull power following a passive warm-up intervention with highly trained swimmers using multiple heated clothing garments., Methods: Using a crossover design, 8 high-performance swimmers (mean [SD]; age, 22.4 [4.4] y; body mass, 74.9 [8.1] kg; height, 1.79 [0.09] m; world record ratio, 107.3% [5.1%]) completed a pool-based warm-up followed by a 35-minute transition phase before completing 3 repetitions at 50% of 1-repetition maximum of the bench-pull exercise. During transition, swimmers wore either a warm (control) or a heated (heat) clothing condition., Results: Following heating, mean skin temperature was 0.7 °C higher in heat (P = .011), though no change was seen in tympanic temperature. Bench-pull mean and peak power improved by 4.5% and 4.7% following heating, respectively. A large repeated-measures correlation was observed between skin temperature and mean (r [90% CI] = .94 [.65 to .99], P < .01) and peak (r [90% CI] = .89 [.45 to .98], P < .01) power output. Thermal sensation and comfort at all regions were higher with heating (P ≤ .02)., Conclusion: Combined upper- and lower-limb passive heating can increase whole-body skin temperature and improve short-duration upper-limb power output during the bench-pull exercise. Improvements in power output were directly related to the skin temperature increase facilitated by the heated clothing.

Background: In swimming, the period between the end of the swimming warmup and the beginning of competition is critical to performance, here termed the transition phase. Several options are available during this phase, necessitating a systematic review to understand if optimal strategies exist., Objectives: To synthesise and critically evaluate the current literature investigating land-based warmup interventions on subsequent performance in competitive swimmers., Methods: A search of three electronic databases (PubMed, EBSCO SPORTDiscus and Web of Science) was conducted to identify original studies until February 2022. Selection criteria dictated that (i) a control condition was used, (ii) participants were ≥ 15 years of age, (iii) a pool-based warmup was done prior to the land-based warmup. A total of 25 articles met the selection criteria., Results: Reducing the transition phase duration by at least half led to consistently faster time-trial times of between 1.1-1.5% for all included studies. Passive warmups using clothing interventions resulted in mostly faster time-trial's of 0.4-0.8% with increases in skin temperature frequent, though little change occurred in core temperature. The methodology of passive respiratory warmups were vastly different with positive time-trial's effects ranging between 0.9-1.1% for two studies, though one reported no meaningful difference. Active warmups led to consistently faster time-trial's between 0.7-0.9%, though the unpinning factors are not clear. Warmups which combined passive and active options frequently led to faster time-trial's between 0.8-3%. Upper and combined limb post-activation performance enhancement led to mostly unfavourable time-trial changes. Lower limb exclusive protocols results were inconsistent, with limited beneficial effects on time-trial or start performance reported following plyometric protocols. However, there does appear merit in heavier loaded lower limb protocols., Conclusion: Each of a reduced transition phase length, and passive, active or combination warmup have demonstrated improvements in swimming performance. Conversely, PAPE protocols should be used with caution, especially when including the upper limbs., Competing Interests: The authors have declared that no competing interests exist.

Background: The objective of this study is to assess the clinical and hemodynamic performance of a stentless porcine bioprosthesis, the Freestyle aortic root bioprosthesis., Methods: Consenting patients requiring isolated aortic valve or aortic root replacement received the Freestyle bioprosthesis. Clinical follow-up and echocardiographic data were obtained at discharge, 3 to 6 months, 1 year, and annually thereafter., Results: Two hundred seventy-six patients received a Freestyle aortic root bioprosthesis between January 1993 and July 1997. The mean age was 67.7 years. Preoperatively, 86.3% were either New York Heart Association class III or IV. Two hundred thirty-eight patients underwent valve (subcoronary) replacement, 36 underwent aortic root replacement, and 2 underwent valve replacement using the root-inclusion technique. The early mortality was 5.4%, with 3.3% mortality for the subcoronary technique and 19.4% mortality for aortic root replacement. The mean gradient decreased significantly between discharge and the 3- to 6-month follow-up and stabilized thereafter. The effective orifice area increased significantly from discharge to 3 to 6 months' follow-up. At 3 years, 84.4% of the patients had either no or trivial regurgitation., Conclusions: The Freestyle bioprosthesis has good clinical performance and good short-term hemodynamic performance. The majority of the regurgitation identified is not clinically significant.

Background: The Freestyle prosthesis is a new stentless aortic bioprosthesis. Anticipated benefits are improved hemodynamics and increased longevity., Methods: Doppler echocardiograms were performed early and at 3 to 6 months, 1 year, and 2 years after operation in 157 patients (69 men, 88 women, aged 48 to 85 years) with this prosthesis, and results were compared with hemodynamic data in patients with Intact and Mosaic stented bioprostheses., Results: Distinctive features of the prosthesis compared with stented prostheses are (1) an increase in effective orifice area (+0.15+/-0.26 cm2; p < 0.05) and a decrease in mean gradient (-3.5+/-4.0 mm Hg; p < 0.001) during the first 3 to 6 months postoperatively and stabilization thereafter; (2) a markedly lower mean gradient at 1 year after operation (average, 6+/-4 mm Hg) than in stented prostheses (Intact, 22+/-8 mm Hg; Mosaic, 12+/-6 mm Hg); (3) in contrast to stented prostheses, in vivo effective orifice areas much lower (-0.91+/-0.35 cm2) than those calculated in vitro; (4) as in stented prostheses, the indexed effective orifice area (cm2/m2) is the best predictor (r = 0.77 at 1 year) of the mean gradient after operation; and (5) similar incidence of aortic regurgitation (trivial or mild, 34% versus 29% in Intact)., Conclusions: The hemodynamics of the Freestyle are very satisfactory and represent a marked improvement in comparison to stented prosthesis.

Eighty-one consecutive patients with distal multivessel coronary artery disease underwent 93 attempts at operative transluminal angioplasty at the time of coronary bypass operation. Lesions chosen for angioplasty were those in coronary arteries that otherwise would not have been bypassed because of small size and/or inaccessible location; 53% involved the distal anterior descending artery. A guide wire-tipped catheter with a 2 mm balloon was found to be the more satisfactory of the two devices used. An operative "successful" dilatation was achieved with 75 lesions (81%). Eighteen "unsuccessful" dilatations occurred primarily because of inability to transverse the lesions with the catheter. Postoperative angiography was performed in 29 patients to study 31 lesions. In 20 of 28 "successfully" dilated lesions (71%), the stenoses were completely alleviated. Three lesions were found unimproved and in two lesions, the coronary arteries were occluded distally. Two bypass grafts, involving two lesions with extensive dilatation, were closed. Two patients had definite perioperative myocardial infarction, and there were no deaths in this series. Whereas calcification did not influence success, the length of the lesion was inversely proportional to a successful dilatation. Operative dilatation of short coronary distal lesions is safe, has a high percentage of success, and offers a larger distal runoff for coronary bypass grafts. Areas of normal coronary arteries should not be dilated. Careful attention to detail and proper selection of the lesions to be dilated are required. The technique should be used only to dilate arteries that otherwise would not accept a bypass graft.

Distal coronary artery disease often reduces the feasibility and effectiveness of coronary bypass surgery to specific vessels. Operative transluminal angioplasty (OTA) is a valuable adjunct to coronary bypass surgery without significant sequelae. OTA should not be used to supplant coronary bypass; rather, if should be used to augment that procedure. We report our experience with 24 patients who underwent OTA. Twenty-nine lesions were dilated: 17 distal lesions in a primary coronary artery limiting runoff, six tandem lesions that would otherwise not warrant separate grafts, and six lesions in coronary branches and large enough to accept a bypass graft. Catheter dilatations were performed with 20-mm-long balloons inflated to an external diameter of 2-3 mm. Hand inflation monitored by direct vision for 10 second was used for dilatation. Severe stenosis prevented passage of the balloon across lesions in four cases. Stenoses in 25 lesions would not allow passage of a 0.5-1 mm probe before dilatation. After successful dilatation, passage of 1.5-2.0-mm probes was possible. Repeat cardiac catheterization was performed on eight patients 10 days to 4 months postoperatively. Seven patients improved, one did not improve, and there were no closures, extravasations or aneurysms. One hypercoagulable patient required reoperation for two early graft occlusions at 8 days. There were no perioperative infarctions or deaths.